Postpartum fever, tachycardia that parallels the rise in temperature, midline lower abdominal pain, and uterine tenderness are the key clinical findings in women with endometritis, and are present in most women.

The diagnosis of postpartum endometritis is clinicaland largely based upon the presence of postpartum fever that cannot be attributed to another etiology after a thorough history and physical examination.

She has a remote history of pneumonia and resulting respiratory failure requiring intubation. She denies recent viral illness, fever, trauma, or inhalational injury. She has no history of heart failure.

On exam she is tripod-ing and working hard to breathe. No rales are heard but she is taking shallow breaths at a rate of 60 per minute.

Increasing PEEP may be useful in the ER to help maintain adequate oxygenation. Increased PEEP may also help stabilize lung volume and prevent further lung injury longer term, but this is not entirely clear.

Prone positioning – not something I would necessarily do in the ER but may be worth thinking about if the patient remains hypoxemic despite other efforts. Call a pulmonologist.

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This blog is meant as a forum for education and discussion. The information in this blog is meant to be as accurate as possible, however the accuracy or completeness of the information cannot be guaranteed. The contents of this blog should not be interpreted as medical advice for patients, and health care professionals should continue to use their clinical judgement in their daily practice.